African American Sample Research Articles

Use of the NIH Toolbox for assessment of mild cognitive impairment and Alzheimer's disease in general population, African‐American and Spanish‐speaking samples of older adults

AbstractBackgroundThe world population is rapidly aging, and the prevalence of dementia due to Alzheimer’s disease (AD) and related disorders is correspondingly increasing. Thus, detecting cognitive decline in older individuals is an urgent public health concern. There is a need for brief, practical, standardized measures that are sensitive to cognitive decline and can be broadly deployed in diverse settings. Advancing Reliable Measurement in Alzheimer's Disease and Cognitive Aging (ARMADA) aims to meet this need by validating the NIH Toolbox for Assessment of Neurological and Behavioral Function® (NIHTB®) in individuals ages 65 to 85 who are cognitively healthy or diagnosed with either mild cognitive impairment (MCI) or dementia of the Alzheimer type (AD). A broad range of clinical and healthy samples have been recruited to date, including an African American sample and a Spanish‐speaking Hispanic sample to reflect the diversity of people affected by cognitive decline and to enable validation of the Spanish NIHTB. We will present baseline NIHTB results for each sample.MethodIndividuals age 65 or older who are either cognitively normal or diagnosed with cognitive impairment (MCI or early AD) have been recruited from nine clinical centers with established research cohorts. Participants complete the NIHTB and gold standard neuropsychological assessment at baseline. AD biomarkers, including PET beta amyloid level, CSF tau, and APoE genotype, are also available.ResultAs of January 2020, 656 participants have completed the baseline assessment. Early results indicate the NIHTB Cognition battery, as well as individual measures, successfully discriminates among MCI, AD and healthy controls in the general population sample (N=259). Baseline data collection for the African American and Hispanic samples will be largely complete by June 2020, and initial results will be presented.ConclusionInitial baseline results from the ARMADA study provide evidence that the NIHTB discriminates among older individuals with normal cognition, MCI, and early AD. Two annual longitudinal follow‐ups will evaluate how well NIH Toolbox measures predict future cognitive decline, their sensitivity to change and their association with AD biomarkers.

Shared genetic etiology underlying late‐onset Alzheimer’s disease and post traumatic stress syndrome

AbstractBackgroundPatients with late‐onset Alzheimer’s Disease (LOAD) frequently manifest comorbid neuropsychiatric symptoms (NPS) with depression and anxiety being most prevalent. Posttraumatic stress disorder (PTSD) is a neuropsychiatric condition that is highly comorbid with depression and anxiety and PTSD patients also have an increased risk for developing dementia. These evidences suggest the possibility of shared etiologies and intersecting pathways between LOAD and PTSD. We investigated genetic pleiotropy between LOAD and PTSD.MethodWe assessed genetic pleiotropy by using a conditional false discovery rate framework based on GWAS summary statistics: LOAD (IGAP, ADG Consortium study of genetic risk for Alzheimer’s disease in African Americans); PTSD (Psychiatric Genomics Consortium PTSD GWAS (discovery), the Genetic and Environmental Predictors of Combat‐Related PTSD study (replication). Functional bioinformatics and gene expression analysis was completed for genes that replicated in the discovery and replication cohorts.ResultWe found enrichment of 2.2‐5.6 fold for SNPs associated with LOAD across increasingly stringent levels of significance with PTSD association. The reverse conditional association showed a modest enrichment of approximately 1.3‐5.0 fold. Similar fold enrichment was observed for the African American samples. Six genes were identified as FDR significant for the association with LOAD conditional on PTSD for both the discovery and replication cohorts. Four genes in the MS4 gene family replicated in the two independent PTSD datasets, pointing to a role for genes associated with immunity in the shared genetic signature. These genes showed a shared, consistent expression pattern in the cerebellar hemisphere and cerebellum and a similar expression pattern in the amygdala, hippocampus, cortex and frontal cortex. Cross‐brain‐tissue analysis identified a significant association (P = 2.9 × 10−7) for the MS4A6A gene. There were no FDR significant results in either direction for the African American dataset.ConclusionIdentifying common genetic signatures for LOAD and PTSD advances understanding of shared genetic etiologies and impaired pathways between these conditions. Our data suggest that immune function genes may play a role in both PTSD and LOAD, implicating common pathways. This knowledge provides insights for actionable targets to treat NPS earlier in life to delay or ultimately prevent the onset of LOAD.

Abstract 17306: Primary Prevention Aspirin Use Trends and Associations With Health Beliefs Among African Americans, 2015-2019

Introduction: Cardiovascular disease (CVD) disproportionately affects African Americans. Aspirin has long been recommended as an option to reduce cardiovascular events. However, recent clinical trials involving primary prevention aspirin have prompted changes in national guidelines restricting the aspirin recommended population. Hypothesis: Primary prevention aspirin use will decline over the 5 year period 2015-2019. Methods: Using 3 cross-sectional surveys, data were collected from self-identified African Americans in 2015, 2017 and 2019, querying information on CVD risk factors, health behaviors and beliefs, and aspirin use. Poisson regression modeling was used to estimate age- and risk-factor adjusted aspirin prevalence, trends and associations. Results: A total of 1,491 African Americans adults, ages 45-79, 61% women and no prior CVD completed surveys and were included in this analysis. There was no change in age- and risk factor-adjusted aspirin use over the 3 surveys for women (37%, 34% and 35% respectively) or men (27%, 25%, 30% respectively). However, fewer participants believed aspirin was helpful in 2019--75% vs 84% in 2015 (p<0.05). In the total sample (n=1,491) aspirin discussions with a health care practitioner were highly associated with aspirin use (aRR 2.97, 95% CI 2.49-3.54), as were several health beliefs and social norms that affirm preventive behaviors and aspirin use (Figure). Conclusion: Despite major changes in national guidelines and negative perceptions of aspirin effectiveness in the media, overall primary prevention aspirin use did not significantly change in this African American sample from 2015 to 2019.

Abstract 14735: Volatile Organic Compounds Are Associated With Lower Ankle-Brachial Indexes in African Americans of the Jackson Heart Study

Introduction: Cigarette smoking is associated with peripheral artery disease (PAD) in African Americans (AA), but the association between cigarette constituents and PAD remain inadequately studied. We evaluated the effect of volatile organic compounds (VOC) acrolein and crotonaldehyde on ankle-brachial index (ABI) as well as related biomarkers in AA participants of the Jackson Heart Study. Methods: Urinary VOC concentrations were measured in a subset of participants at baseline including 345 self-reported current smokers and 718 never smokers. Multivariable linear regression assessed the association between ABI and VOC concentrations after adjustment for acute (cotinine) and chronic (pack-years) smoking measures in models 1 and 2, respectively. The degree of association was assessed after adjusting for possible mediation (Baron & Kenny procedure) by C-reactive protein (CRP), fibrinogen, and homocysteine (HCY) concentrations. VOC concentrations were natural log transformed for normal distribution and all models adjusted for relevant covariates. Results: The mean age of included participants was 52 years and 49% women. Individuals who smoked were more likely to be men, less educated, have prevalent cardiovascular disease, and lower mean ABI. In model 1, ABI was inversely associated with urinary acrolein and crotonaldehyde concentrations. Model 2 retained the inverse ABI association for both VOC. Crotonaldehyde was directly associated with CRP and HCY in models 1 and 2. In model 1, acrolein was associated with HCY (Table). Biomarker mediation of the VOC-ABI relationship was insignificant. Conclusions: Acrolein and crotonaldehyde concentrations are associated with lower ABI and higher measures of inflammation and thrombosis in a community-based sample of AA. These findings suggest reduction in VOC exposure may reduce the risk of PAD in AA who smoke cigarettes.

Racial discrimination and posttraumatic stress: examining emotion dysregulation as a mediator in an African American community sample

ABSTRACT Background: African Americans experience more severe and chronic posttraumatic stress disorder (PTSD) symptoms compared to other racial groups, and thus it is important to examine factors that are relevant for the aetiology of PTSD in this population. Although racial discrimination has been implicated as an exacerbating factor in the development and maintenance of PTSD, relatively less is known about mechanisms through which this process may occur. Objective: The purpose of this study was to examine one such mechanism, emotion dysregulation, in two independent samples of African American adults. Method: Trauma-exposed participants were recruited in a large, urban community hospital setting (initial sample n = 1,841; replication sample n = 294). In the initial sample, participants completed a unidimensional measure of emotion dysregulation and self-reported PTSD symptoms based on the DSM-IV. In the replication sample, participants completed a multidimensional measure of emotion dysregulation and a diagnostic interview of PTSD symptoms based on the DSM-5. Mediation analyses were used to test our hypotheses. Results: Across both samples, results indicated that racial discrimination was indirectly associated with PTSD symptoms through emotion dysregulation (even when trauma load was added as a covariate). Conclusions: Taken together, these results provide strong evidence that the association between racial discrimination and PTSD symptoms may be partially explained by the association between racial discrimination and worse emotion dysregulation. These findings elucidate the impact of racist incidents on mental health and identify modifiable emotion regulatory processes that can be intervened upon to enhance the psychological and social wellbeing of African Americans.

Incorporating a Race Salience Subscale Into the Cross Racial Identity Scale (CRIS)

In this study, we examined the internal consistency and structural validity of scores on an expanded version of the Cross Racial Identity Scale (CRIS) consisting of the original six subscales—Assimilation, Miseducation, Self-Hatred, Anti-White, Afrocentricity, and Multiculturalist Inclusive—and a seventh subscale called Race Salience. Participants consisted of two samples of African Americans. Sample 1 had 324 participants, most of whom were students at historically Black institutions, and Sample 2 had 340 students attending a predominantly White institution. CRIS subscale scores, including Race Salience were internally consistent in Sample 1, and an exploratory factor analysis supported the structural validity of the race salience score. A confirmatory factor analysis provided support for the seven-factor structure. Internal consistency and structural validity results were replicated in Sample 2. Future studies should examine other aspects of construct validity on this expanded version of the CRIS, such as convergent and discriminant validity, and the impact of seven subscales on the number and type of racial identity profiles that CRIS scores can yield.

Predictors of Feminist Identity Utilizing an Intersectional Lens With a Focus on Non-Hispanic White, Hispanic, and African American MSW Students

A fundamental value of social work is social justice, which includes gender and racial/ethnic equality. Feminists address gender-based oppression and often work to address racial/ethnic inequalities as well as many other forms of oppression. However, most literature suggest that less than half of social work students identify as feminists. This study investigated factors that contribute to student feminist self-identification, focusing on how racial/ethnic identity may influence feminist identity. Four predicting constructs were identified: method of exposure to feminism, feminist knowledge, feminist attitudes and ideologies, and description of feminists. A multiple regression model was applied to the overall sample ( N = 660) and to each racial/ethnic group. Findings indicate that in the overall sample, all four constructs significantly contributed to predicting feminist identification, while in the non-Hispanic white sample ( n = 366), method of exposure, feminist attitudes and ideologies, and description of feminists made significant contributions; for the Hispanic sample ( n = 157), only feminist attitudes and ideologies made significant contributions to predicting feminist identification; and for the African American sample ( n = 137), method of exposure and description of feminists made significant contributions. These findings indicate differences among racial/ ethnic background in feminist identity and provide a comprehensive picture of feminist identity among Master’s of Social Work (MSW) students.

The Protective Effects of Social Support on Hypertension Among African American Adolescents Exposed to Violence.

African Americans develop hypertension earlier in life than Whites and the racial/ethnic disparities in blood pressure level can appear as early as adolescence. Violence victimization, a prevalent environmental stressor among inner-city youth, may play a role in such disparities. In a sample of inner-city youth in the United States, the current study examines the relationship between violence victimization and hypertension while investigating the role of social support in moderating that relationship. We analyzed eight waves of data from a longitudinal study of African American youth (n = 353, 56.7% female) from mid-adolescence (9th grade, mean age = 14.9 years old) to emerging adulthood (mean age = 23.1 years old) using probit regression. Higher levels of self-reported violence victimization during ages 14-18 was associated with more reports of hypertension during ages 20-23, after adjusting for sex, socioeconomic status, substance use, and mental distress. The relationship of violence victimization with hypertension was moderated by friends' support, but not parental support. The association between victimization and hypertension was weaker and non-significant among individuals with more peer support compared to those with less support. Researchers have reported many instances of associations of early violence exposure to later risk for hypertension; however, most have focused on childhood maltreatment or intimate partner violence. We extend these findings to violence victimization in an African American sample of youth from adolescence to early adulthood, while examining social support modifiers. The disparity in African American hypertension rates relative to Whites may partly be explained by differential exposure to violence. Our findings also suggest that having supportive friends when faced with violence can be beneficial for young adulthood health outcomes.

A longitudinal examination of social support as a mediator of the personality-health relationship in a national sample of African Americans.

The present study investigates whether social support mediates the relationship between personality traits and health among African Americans over a five-year period, filling a gap in the literature on longitudinal tests of the personality-health association. Data were collected from a national probability sample of African American adults (N = 200). Personality was assessed at Time 1 (T1), social support was assessed 2.5 years later (T2), and physical functioning was examined 5 years (T3) after T1. Telephone surveys included measures of the Five Factor Model personality traits (T1), social support (T2), and physical functioning (T3). Results suggested that relationships between the T1 personality traits and T3 physical functioning were not mediated by T2 social support. Secondary analyses found that among all T1 personality traits, higher openness and lower neuroticism uniquely predicted higher T2 social support. Further, among T1 personality traits, higher conscientiousness uniquely predicted better T3 physical functioning. This information may be useful to healthcare providers and community members in developing prevention and intervention strategies for African Americans.

The contributions of everyday and major experiences of racial discrimination to current alcohol use and regular smoking in Black adults: Considering variation by demographic characteristics and family history

Background: Racial discrimination has consistently been linked to elevated alcohol use and smoking in Black adults, but the independent contributions of everyday and major experiences of discrimination have rarely been investigated. The present study aimed to identify variation in magnitude of the links between each type of racial discrimination with current frequency of alcohol use and regular smoking by demographic characteristics and family history of problem drinking/regular smoking in Black adults in the U.S. Methods: Data were drawn from 4462 adults (29.40% Afro Caribbean, 70.60% African American; 63.20% female) in a nationally representative sample of Black Americans. Logistic regression analyses were conducted to predict current frequency of alcohol use and regular smoking using the Everyday Discrimination Scale (EDS) and Major Experiences of Discrimination Scale (MEDS), testing for interactions with demographic characteristics and family history. Results: In the alcohol model, an EDS by education level interaction was observed: OR = 1.04 (CI:1.02–1.07) for < high school; OR = 0.95 (CI:0.92–0.98) for ≥ high school. MEDS was independently associated with alcohol use (OR = 1.11, CI:1.04–1.18). In the smoking model, EDS was associated with elevated risk (OR = 1.03, CI:1.01–1.04) and a MEDS by age cohort interaction was observed: OR = 1.24 (CI:1.11–1.38) for <age 45; OR = 1.07 (CI:0.97–1.19) for ages 45–65. Conclusions: Everyday and major experiences of racial discrimination contribute independently to both alcohol use and regular smoking in Black adults, with some variation by education level and age. Differentiating everyday from major experiences of discrimination in studies of mechanisms linking racial discrimination to substance use will enhance their informativeness for intervention development.

Low Birth Weight and Psychoeducational Outcomes: Investigation of an African American Birth Cohort

African Americans experience more than double the prevalence of low birth weight (LBW)/premature birth compared to their Caucasian counterparts, reflecting a public health crisis and a significant social justice concern. However, there is a paucity of LBW outcome studies in African American samples. There are even fewer that investigate developmental outcomes within the moderately LBW range (i.e., 1500–2500 g), the most prevalent category of LBW births. This study investigates the relationship between LBW and various psychoeducational outcomes in a prospectively designed African American birth cohort. Multivariate logit analyses of the Johns Hopkins University Pathways to Adulthood study compared LBW children with normal birth weight children on a number of outcome measures at seven and 8 years of age. Results revealed that children born within the lowest birth weight category produced the most adverse findings, from both a statistical and clinical standpoint, on measures of cognitive ability, academic achievement, speech, language, auditory processing, and visual–motor integration.

“Black folks do forage”: Examining wild food gathering in Southeast Atlanta Communities

Concerns about food sovereignty in western nations have increased in recent years, as incidents of food-borne pathogens are highlighted in the popular press, and calls for locally-sourced food have increased. Wild food foraging has emerged as a response by some segments of the population under the twin rubrics of food sovereignty and food justice. However, virtually all studies looking at these activities focus outside of the U.S. South and contain little information on African American involvement. We investigate both perceptions and participation in urban foraging by African Americans in Atlanta’s Browns Mill-Lakewood community and smaller sections of adjacent communities, with attention to the role of collective efficacy as a predictor of foraging and foraging as a precursor of collective efficacy. A modified proportionate, census guided, systematic random sampling method was used to administer a door-to-door, household survey in the study area to gather these data. Twenty percent of the nearly all African American sample indicated that they had foraged in their neighborhood in the past five years, but not being aware of wild food locations was the most-cited barrier to participating. Results from ordered, logistic regression models also indicated that women were significantly less likely than men to forage, other factors equal; and those who foraged were more likely to have higher collective efficacy scores. Recommendations are made for increasing awareness of wild food locations in southeast Atlanta communities. This involves partnering with a local foraging non-profit group, Concrete Jungle.

Persistence of skin-deep resilience in African American adults.

The skin-deep resilience pattern suggests that, for low-socioeconomic-status African American youths, the ability to maintain high self-control and to persist with efforts to succeed may act as a double-edged sword, facilitating academic success and adjustment while undermining physical health. We extend research by following a sample of rural African Americans, asking whether the skin-deep resilience pattern, evident during adolescence, persists into adulthood by increasing susceptibility to metabolic syndrome (MetS) and insulin resistance (IR). The sample included 368 11-year-old African Americans, their parents, and their teachers. Parents provided data on family poverty across ages 11-18 years. Teachers provided data on youths' planful self-control across ages 11-13 years. At age 27 years, participants completed questionnaires about educational attainment and psychological adjustment and provided a fasting blood sample from which MetS and IR were assessed. Regardless of years spent living in poverty, planful self-control during childhood was associated with college graduation (p < .001) and with low levels of depressive symptoms (p = .016) and antisocial behavior (p = .028). For participants exhibiting high levels of self-control, however, living more years in poverty across adolescence was associated with a greater number of MetS components that met clinical cutoff criteria (p = .018) and greater IR (p = .016) during adulthood. The skin-deep resilience pattern persists into adulthood, particularly among those who spent more of their adolescence living in poverty, and increases vulnerability to MetS and IR while it also promotes college graduation and positive psychological adjustment. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Societal Actors Shape Collective Identities of Minorities: Procedural Fairness Climate Effects on Identification, Subjective Well-Being and Psychological Health

In the present studies, we aimed to show that the perceived procedural fairness of societal actors’ multicultural decisions promotes ethnic minority members’ societal identification. These enhanced identification levels, in turn, contribute to better psychological health and well-being. Firstly, a vignette study in a sample of African Americans explored the effect of procedural fairness climate on identification. The second and third studies used self-report questionnaires. Study 2 consisted of a sample of sojourners in a university context, Study 3 analyzed online data through an African American sample. The studies provided evidence for the effect of procedural fairness climate on increased societal identification, which in turn mediates the fairness effect on increased well-being and psychological health. Societal actors can use procedural fairness to increase well-being when making decisions that involve ethnic minorities.

Interpersonal and Structural Social Isolation among African American and Black Caribbean Men

Social relationships are important for promoting health and well-being in men and confer many benefits that help prevent the onset and mitigate adverse impacts of disease and disability. Social isolation, or the absence of social relationships, is associated with a wide range of negative health outcomes; however, most studies of social isolation have been conducted among predominantly White samples. As a consequence, we know very little about social isolation among Black men. Using an intersectionality framework, this study examines the prevalence and correlates of social isolation among men who identify as African American or Black Caribbean. Data come from the National Survey of American Life (NSAL), a nationally representative sample of African Americans, Black Caribbeans, and Whites living in the United States. The current study focuses on men who identified as African American or Black Caribbean. Further, within this sample, we distinguish by ethnicity and nativity in examining Black men who are African American (native to the U.S.), U.S.-born Black Caribbean men, and foreign-born Black Caribbean men. Social isolation was operationalized using two constructs: interpersonal isolation and structural isolation. The analyses adjusted for age, education, income, marital status, and region. We conducted a series of Poisson regressions to determine: (1) ethnic differences in interpersonal and structural social isolation and (2) ethnic-specific correlates of interpersonal and structural social isolation among Black men. All analyses accounted for the complex study design of the NSAL. There were no significant ethnic differences among Black men for interpersonal isolation. However, U.S. born Black Caribbean men had higher rates of structural social isolation compared to African American men and foreign-born Black Caribbean men. There were very few differences in the correlates of interpersonal isolation among Black men regardless of ethnicity. However, in terms of structural isolation, African American men had more significant correlates in comparison to U.S. born Black Caribbean men and foreign-born Black Caribbean men.

Determining our destiny: Do restrictions to collective autonomy fuel collective action?

Groups experience collective autonomy restriction whenever they perceive that other groups attempt to limit the freedom of their group to determine and express its own identity. We argue that collective autonomy restriction motivates groups (both structurally advantaged and disadvantaged) to improve their power position within the social hierarchy. Four studies spanning real-world (Studies 1 and 2) and lab-based (Studies 3 and 4) intergroup contexts supported these ideas. In Study 1 (N = 311), Black Americans' (a relatively disadvantaged group) experience of collective autonomy restriction was associated with greater support for collective action, and less system justification. In Study 2, we replicated these findings with another sample of Black Americans (N = 292). We also found that collective autonomy restriction was positively associated with White Americans' (a relatively advantaged group, N = 294) support for collective action and ideologies that bolster White's dominant position. In Study 3 (N = 387, 97 groups), groups that were susceptible to being controlled by a high-power group (i.e., were of low structural power) desired group power more when their collective autonomy was restricted (vs. supported). In Study 4 (N = 803, 257 groups) experiencing collective autonomy restriction (vs. support) increased low-power group members' support of collective action, decreased system justification, and evoked hostile emotions, both when groups were and were not materially exploited (by being tasked with more than their fair share of work). Across studies, we differentiate collective autonomy restriction from structural group power, other forms of injustice, group agency, and group identification. These findings indicate that collective autonomy restriction uniquely motivates collective behavior. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Africultural Coping Systems Inventory: Psychometrics in a Clinical Sample of African American Women

The Africultural Coping Systems Inventory (ACSI) assesses African Americans’ culturally relevant stress coping strategies. Although its factor structure, reliability, and validity of the scores have been examined across ethnic groups of African descent, psychometric properties have not been investigated in an African American clinical sample. Thus, it is unclear if the ACSI is useful for research with African Americans with distress. To assess the ACSI’s psychometrics, we used data from 193 low-income African American women who in the past year encountered interpersonal trauma and attempted suicide. We tested four models: one-factor, four-factor, four-factor hierarchical, and bifactor. None of the models were optimal, suggesting possible revisions to ACSI items. Yet the bifactor model provided a better fit than other models with items loading onto a general factor and onto specific factors. Internal consistency of the scores was above the recommended criterion (i.e., .70), and the ACSI general factor was related to depressive symptoms, suicidal ideation (but not alcohol abuse), providing some support for its concurrent validity. Future directions, limitations, and clinical-counseling implications are discussed.

Neurological complications in a predominantly African American sample of COVID-19 predict worse outcomes during hospitalization

People with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, COVID-19, can have neurological problems including headache, anosmia, dysgeusia, altered mental status (AMS), ischemic stroke with or without large vessel occlusion, and Guillen-Barre Syndrome. Louisiana was one of the states hit hardest by the pandemic with just over 57,000 laboratory-confirmed cases of COVID-19 by the end of June 2020.We reviewed the electronic medical records (EMR) of patients hospitalized during the peak of the pandemic, March 1st through March 31st, to document the type and frequency of neurological problems seen in patients with COVID-19 at presentation to the emergency room. Secondary aims were to determine: 1) the frequency of neurological complaints during the hospital stay; 2) whether the presence of any neurological complaint at presentation or any of the individual types of neurological complaints at admission predicted three separate outcomes: death, length of hospital stay, or the need for intubation; and 3) if the presence of any neurological complaint or any of the individual types of neurological complaints developed during hospital stay predicted the previous three outcomes.A large proportion of our sample (80 %) was African American and had hypertension (79 %). Out of 250 patients, 56 (22 %) patients died, and 72 (29 %) patients required intubation. Thirty-four (14 %) had a neurological chief complaint at presentation; the most common neurological chief complaints in the entire sample were altered mental status (AMS) (8 %), headache (2 %), and syncope (2 %). We used a competing risk model to determine whether neurological symptoms at presentation or during hospital stay were predictors of prolonged hospital stay and death. To establish whether neurological symptoms were associated with higher odds of intubation, we used logistic regression. Age was the only significant demographic predictor of death and hospital stay. The HR (95 %CI) for remaining in the hospital for a ten-year increase in age was 1.2, (1.1, 1.3, p < 0.0001), and for death was 1.3, (1.1, 1.5, p < 0.01).There were no demographic characteristics, including age or comorbidities predictive of intubation. Adjusting for age, patients who at presentation had neurological issues as their chief complaint were at significantly increased risk for remaining in the hospital, HR = 1.7, (1.1,2.5, p = 0.0001), and dying, HR = 2.1(1.1,3.8, p = 0.02), compared to patients without any neurological complaint. Of the individual admission complaints, AMS was associated with a significantly prolonged hospital stay, HR = 1.8, (1.0–3.3, p = 0.05). Patients that required dialysis or intubation or had AMS during hospitalization had more extended hospital stays. After adjusting for age, dialysis, and intubation, patients with AMS during hospital stay had a HR of 1.6, (1.1, 2.5, p = 0.01) for remaining in the hospital. Patients who had statistically significant higher odds of requiring intubation were those who presented with any neurological chief complaint, OR = 2.8 (1.3,5.8, p = 0.01), or with headaches OR = 13.3 (2.1,257.0, p = 0.008). Patients with AMS during the hospital stay, as well as those who had seizures, were more likely to need intubation. In the multivariate model, dialysis, OR = 4.9 (2.6,9.4, p < 0.0001), and AMS, OR = 8.8 (3.9,21.2, p < 0.0001), were the only independent predictors of intubation.Neurological complaints at presentation and during the hospital stay are associated with a higher risk of death, prolonged hospital stay, and intubation. More work is needed to determine whether the cause of the neurological complaints was direct CNS involvement by the virus or the other systemic complications of the virus.

African Americans and COVID-19: Beliefs, behaviors and vulnerability to infection

ABSTRACT In the United States, during the early outbreak of the coronavirus (COVID-19) pandemic, African Americans experienced disproportionately high rates of infection and mortality relative to their share of the United States population. New Orleans, Louisiana was one of the places most heavily affected by the coronavirus during its early outbreak. The study that follows explores the attitudes of African Americans in New Orleans toward the virus, social and normative conditions which affected individual behaviors, as well as access to healthcare services and COVID-19 testing. In part one of the study, qualitative responses were collected from a sample of African Americans in the New Orleans area to garner perspective about their attitudes and behaviors related to the coronavirus outbreak. Part two of the study builds on findings from Study 1 with parameter estimates from a Logit regression to examine how social, economic and physical conditions determine vulnerability to COVID-19 infection among African Americans. Implications for how healthcare organizations can address the needs of vulnerable populations during a health-related crisis are discussed.

The Index of Race-Related Stress-Brief: Further Validation, Cross-Validation, and Item Response Theory-Based Evidence

The Index of Race-Related Stress-Brief (IRRS-B) is one of the most widely used measures to assess race-related stress among Black Americans. Despite a long history of use in research and clinical settings, there has been limited scholarship examining the factor structure of the IRRS-B. In this study, we evaluated the item functioning and structural performance of the IRRS-B scores in a nationally recruited sample of Black Americans using item response and confirmatory factor analyses. Item-level analyses illustrated that items on the IRRS-B, in general, tended to be most informative at moderate levels of the latent construct. The proposed three-factor structure yielded a comparable fit to the data in a validation and a cross-validation subsample but did not meet recommended cutoff values for adequate model fit. Findings are discussed in terms of the implications for future use of the IRRS-B in research and clinical contexts.